Unclaimed bodies are anatomy's shameful inheritance

Medical science must stop using the bodies of some of society’s most vulnerable people for dissection, says anatomist Gareth Jones

TWO hundred years ago there were riots in America and attacks on high profile figures in England and Scotland. They were not sparked by hunger, poverty or a yearning for political reform. Instead it was public repulsion on realising that bodies of the recently dead had been stolen from graveyards, obtained by deception from hospitals, or worse, and spirited away. Their destination? Dissection in the name of the medical sciences that were blossoming at the time.

In an attempt to end this situation, the UK passed the Anatomy Act of 1832. This meant that anatomists, rather than having to rely on grave robbers, had legal access to the unclaimed corpses of people who had died in workhouses or in prison, supplemented in later years by those who died in mental hospitals. Supply met growing demand and public anger abated.

But the probably unintended and unforeseen result was to make poverty the sole criterion for dissection. It also set in stone the legitimacy of using unclaimed bodies for educational and research purposes, something that dominated anatomical practice in many countries until the 1950s or later. And while such practice is no longer accepted in much of the world, it continues in a surprising number of locations. It is high time it stopped.

Unfortunately, unclaimed bodies are still used in countries including South Africa, Nigeria, Bangladesh, Brazil and India. While their use is far less in North America, they continue to constitute the source of cadavers in around 20 per cent of medical schools in the US and Canada. In some states in the US, unclaimed bodies are passed to state anatomy boards. When the scalpel descends on these corpses, no one has given informed consent for them to be cut up.

Bequeathing bodies is quite different. Here, a conscious decision has been taken before death to leave one's body to a medical school. Bequests also enshrine the important ethical principle of altruism – giving something is ethically superior to having it taken from you.

In recent years, the hugely successful public exhibitions of human cadavers preserved by plastination have brought this issue to public attention, and the use of unclaimed bodies has been alleged in some cases. Although the highest profile of these exhibitions, BodyWorlds, says it uses only bequeathed bodies, this might not be the case with some competitors.

The absence of informed consent creates an ethical vacuum that is open to abuse. The most extreme example was during the 1930s and 1940s, when the use of unclaimed bodies reached its peak in Germany and its occupied territories under the Nazi regime. The bodies of those sentenced to death, as well as those from concentration camps, prisons and psychiatric institutions, provided a prolific supply for research and teaching in anatomy departments. The response of leading anatomists in Germany was that the origin of the bodies was morally irrelevant, because they were using them for "good" anatomical purposes.

The bodies of the poor, the marginalised and the disadvantaged end up unclaimed. These are the people on the edges of society, with no one to look after their interests and often considered as having little value during their lives. The bodies of the mentally ill and those of minority racial and cultural groups have frequently fallen into this category. Why do anatomists ignore their interests?

The problem is long-standing. It has generally been legal to use unclaimed bodies, and anatomists have not questioned the ethical underpinnings of this practice. Consequently, the powerful drive for dissection-based learning has trumped other concerns, with scientific and medical aspirations overruling social, economic and moral considerations.

Compromises regularly have to be made between scientific and ethical ideals, especially where human tissue is employed, but acceptable compromises can only be reached if sufficient attention is paid to both the science and the ethics. A profession that ignores the ethical dimensions of its practice has no way of preventing ethical atrocities when individuals or societies go awry.

There are many reasons for the ongoing use of unclaimed bodies. In some countries there has never been an ethos of bequest. Additionally, there are cultural and religious reasons, there is secrecy surrounding medical training and the role of dissection, and there may be a lack of trust in scientific medicine.

The easy solution for anatomists is to obtain unclaimed bodies, sometimes importing them from other countries. No matter what the predicament, this is not an ethical way forward. Anatomists are not entitled to a steady supply of bodies. They have a responsibility to educate members of their local and national communities, to show them that their bodies and those of their loved ones, if bequeathed, will be treated with respect, and will be used for good purposes that will eventually benefit their communities.

Human bodies are more than mere scientific material. They are integral to our humanity, and the manner in which this material is obtained and used reflects our lives together as human beings. The scientific exploration of human bodies is of immense importance, but it must only be carried out in ways that will enhance anatomy's standing in the human community.

While the onus is on anatomists to put an end to the use of unclaimed bodies, politicians should play their part by ensuring that human-tissue legislation is extended for this purpose. Both have a role in ending an injustice still visited on vulnerable members of many societies.

This article appeared in print under the headline "Over my dead body"

Gareth Jones is an emeritus professor in anatomy and a former director of the bioethics centre at the University of Otago, New Zealand. He is co-author of Speaking for the Dead: The human body in biology and medicine

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